TMS Process, Stage 2

The basic premise in Stage 2 is that the unconscious fear and anger in Stage 1 can actually induce physiological changes. This is a pretty hard pill for some people to swallow. On the whole, conventional western medicine tends to pooh-pooh the idea of psychosomatic illness. There is, however, growing scientific evidence to support the relationship between emotions and illness. I'll discuss that shortly.

Dr. Sarno developed his TMS theory as a result of working with patients suffering from back and joint pain. He noticed that a large majority (88 percent) of his patients had a previous history of tension-induced conditions such as heartburn, pre-ulcer symptoms, hiatus hernia, irritable bowel syndrome, colitis, spastic colon, tension headache, migraine, eczema, and frequent urination. Not all doctors agree that these disorders are emotionally-induced, but based on his own medical history and his clinical observations at the time, Dr. Sarno felt confident that indeed they were. This correlation between back pain and tension-induced disorders, and the failure of conventional back pain treatments, led him to believe that back pain may be caused by emotional tension.

He noticed that heating pads, massage, and physical therapy, (all of which increase circulation to the applied area) seemed to temporarily alleviate the pain. He hypothesized that the real cause of the pain may be a reduction of blood flow to the soft tissues in the affected area. A reduction in blood flow would mean a reduction of oxygen available to the tissues, and that mildly ischemic state could certainly cause pain. Think of what happens during a heart attack--blood flow to the heart muscle is completely blocked, and the patient compares the resulting pain to an elephant sitting on his/her chest. In the case of back and joint pain, however, there is no permanent damage to the soft tissues because there is only a minor reduction in blood flow. As a matter of fact, Dr. Sarno noticed that once his patients understood and accepted the fact that they were suffering from a tension-induced disorder, their pain quickly went away, and they were able to resume their previous activities. Good as new.

This brings us back to the problem presented at the top of the page--just how does emotional tension actually induce physiological changes throughout the body? Well, here's what we know so far:

The limbic system in the brain has historically been considered the "seat of emotions." It's been thought to be the area of the brain that produces those nasty feelings from Stage 1: fear, anger, etc. Some researchers like Dr. Candace Pert, however, believe that emotions originate in both the head and the body. For our purposes here, it doesn't really matter where they originate. The important point in Dr. Pert's work is this: "Neuropeptides and their receptors thus join the brain, glands, and immune system in a network of communication between brain and body, probably representing the biochemical substrate of emotion." Her work has proven that emotions absolutely have a physiological effect on all parts of our bodies.

Let's see what happens when emotions lead to dysfunction in the immune system. If the immune system does not react strongly enough to foreign invaders, the result is susceptibility to infections: frequent colds, yeast infections, urinary tract infections. Overstimulation of the immune system can cause allergic reactions.

How about the autonomic nervous system? This system, controlled by the hypothalamus, is responsible for the "fight or flight" response. It can instantaneously direct blood flow to or from various areas of the body. This process can cause tension headaches, migraine, back pain, joint pain, nerve dysfunction.

The immune system and the autonomic nervous system are just two examples. Remember that emotions affect all parts of the body. They can certainly affect the endocrine system and its subsequent release of hormones. And TMS theory suggests that emotions also affect the chemistry of the brain itself--meaning that several psychological disorders (depression, anxiety, obsessive-compulsive disorder) are also manifestations of TMS. In the next section, I'll list off many of the known physical and psychological TMS conditions that can be cured simply by identifying the unacceptable, repressed feelings.

Here's what we don't know: We're not sure exactly how the mind/body decides which physiological alterations to make in response to unacceptable emotions. We don't know why some people get back pain, others develop a spastic colon, and still others get migraines. Some alternative medicine practitioners suggest that specific emotions can cause specific symptoms (financial worry causes knee pain, for example), but I really don't think that's the case. I think that you develop the symptoms that will work as the best distraction for you--the ones that you are least likely to attribute to emotional tension. I'll discuss that more in Stage 4.

You may have noticed that I have not mentioned structural abnormalities like herniated discs, degenerated discs, osteoarthritis, spinal stenosis, scoliosis, pinched nerve, spina bifida occulta, spondylolysis, weak or inflexible torso muscles, minor cartilage tears, calcium deposits, minor rotator cuff tears, or soft tissue inflammation (tendonitis, bursitis, fasciitis). That's because none of these are responsible for the pain.

This is another tough idea for pain sufferers to swallow. People with joint pain have usually been to see an orthopedist, a chiropractor, a physical therapist, or a podiatrist to find out what was causing their pain. So they're often told that there are some muscular imbalances surrounding the joint, or perhaps some soft tissue inflammation. None of those are responsible for the pain. Poor posture and muscular imbalances can lead to poorer posture and a reduction in range of motion, but not intense pain. And what is often diagnosed as tendonitis, bursitis, fasciitis, metatarsalgia, shin splints, tennis elbow, sciatica, or carpal tunnel syndrome is, in reality, just an area of soft tissues suffering from mild oxygen deprivation.

Patients usually have x-rays or MRIs that show some whacked out abnormality in their joints or spine. Now I'm not denying the fact that they have some weird-looking joint abnormalities. I'm saying that the abnormalities don't cause pain. Lots of people, who have no pain at all, have all kinds of structural irregularities in their spine. Lots of people who have excruciating pain have no irregularities at all. And some people even have irregularities and pain, but the irregularity is in such an area that it couldn't possibly be responsible for the pain. (Check out this study that shows there is no correlation between disc bulges and back pain.)

Now it is certainly logical to blame the pain on the abnormality that is spotted on the x-ray or MRI, especially when that's the only thing the doctor is taking into consideration. And of course, that's what the practitioner has been trained to do. But after twenty-some years of observing TMS patients, Dr. Sarno has noticed that his patients only permanently eliminate their symptoms when they accept the fact that the structural abnormalities are not causing the problem. He has realized that many of these abnormalities (like osteoarthritis, degenerated discs, minor rotator cuff tears, minor cartilage tears) are simply part of the aging process. Humans have been painlessly developing them with age for eons, but we have only recently acquired the technology to view them with x-ray and MRI machines. As long as a patient believes that there is something "wrong" with their back or other joint, the pain will hang around. Why? Because it's still working as a distraction. It is still successfully keeping the focus away from the unpleasant emotions in the unconscious mind.

Here are a couple other points to remember. The human body has a marvelous capacity to heal. I mean marvelous. If you snap your thigh bone in half, it's as good as new in six weeks. So why in the world would a fall you took ten years ago still cause your back to flare up and cause you pain? Or even the surgery you had a few years ago? Don't you think that the area should have healed by now? And the idea that a minor activity, like bending over to tie your shoes or sleeping on a soft mattress, could possibly "throw your back out" is ridiculous. I'll discuss this fear issue more in Stage 4.

Very often, if a patient has faith in a particular treatment, he or she will get better, regardless of the true effectiveness of the treatment. It's called the placebo effect. The relief is usually temporary, unfortunately, and the symptoms eventually come back. That's essentially what is happening when you undergo the conventional treatments for back and joint pain. Chiropractic, deep massage, physical therapy, cortisone injections, surgery, and all of those retarded products sold at Relax the Back are barking up the wrong tree. They assume that there is something physically wrong with your back. Many of these modalities are good at temporarily relieving the symptoms--because they either temporarily increase circulation in the area, or you have enough faith in the procedure to enjoy the placebo effect. But if you only treat the symptoms, and not the root cause, the symptoms will eventually come back. Or you may develop another version of TMS. It's very common for back pain to suddenly disappear, only to have shoulder pain or migraine or irritable bowel syndrome show up in its place. So now let us observe the various manifestations of TMS...

On to Stage 3.

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